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See a sample rate comparisonCPT 59426 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Antepartum Care Only; 7 Or More Visits
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures for Maternity Care and Delivery |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None U3 TH |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 59426 |
| Medicaid Fee Schedule | View Medicaid rates for 59426 |
National average reimbursement for CPT 59426 by major payers:
$1,154.99
$1,083.38
$1,227.67
$1,165.13
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CPT 59426
5 of 25 sample ratesHigher to lower in this preview
Karin Schott
Columbia University In The City Of New York
$3,901.22Published rateJewel Grant
Westchester Medical Center Advanced Physician Services, P.C
$2,094.45Published rateThomas Shultz
Lester E Cox Medical Center
$1,653.14Published rateTimothy De Santis
South Broward Hospital District
$1,304.77Published rateAngelica Sze
New York City Health And Hospitals Corporation
$688.65Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 59426 vs. Other Surgical Procedures for Maternity Care and Delivery Codes
The CPT 59426 code is part of the Surgery services used for Surgical Procedures for Maternity Care and Delivery. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 59426 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 59425-CPT | Moderate | Antepartum Care Only ; 4-6 Visits |
| 59426-CPT | High | Antepartum Care Only; 7 Or More Visits |
| 59430-CPT | Moderate | Care Of Mother After Delivery, Routine Care Of The Mother After Childbirth (Postpartum Care). |
| 59510-CPT | High | Routine Obstetric Care Includi, Routine Obstetric Care Including Antepartum Care Cesareandelivery And Postpartum Care Routine Obstetric Care Including Antepartum Care Cesarean |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 59426. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 59426 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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